SEN Service Registration Form

Eligibility
● Full-time undergraduates and postgraduates with permanent disabilities or SEN are eligible to register with the SEN Service
● Part-time students with permanent disabilities can register for the on-campus Rehabus service
● Part-time students with SEN are advised to write to the course instructors with medical report(s) for applications for special examination and/or lecture arrangements.

Please complete the following information. All personal information will be kept in strict confidence.

For enquiries on support services for students with SEN, please contact the SEN Service:
Tel: (852) 3943 5441 / 3943 0338
E-mail: sens@cuhk.edu.hk

1Personal Information > 2Emergency Contact > 3Study Information > 4Nature of SEN > 5Application for Special Accommodations > 6Informed Consent
1a. Name (in English): 1a. Name (in English): First Last
1b. Name (in Chinese):
1c. HKID No.:
1d. Date of Birth: 1d. Date of Birth: / DD / MM YYYY
1e. Student ID No.:
Must be 10 digits. Currently Entered: 0 digits.
If you don't have a student ID, kindly use "0000000000" as a placeholder.
1f. Gender:

1f. Gender: Male Female Other: Other:
1g. Place of Birth:

1g. Place of Birth: Hong Kong Other: Other:
1g. No. of Years of Residence in HK:
1h. Contact Phone No.:
1i. Email Address:
Disclaimer The personal data collected will be used by SEN Service (SENS) and authorised personnel for processing the captioned purposes in accordance with relevant provisions of the Personal Data (Privacy) Ordinance.